Angina

Question 1

1) Beta Blockers (propranolol, metoprolol) 2) CCB (verapamil, nifedipine) 3) Organic Nitrates (nitroglycerin) 4) Drug that increases myocardial efficiency (ranolazine)

Answer 1

1) BB- Decreases AV conduction 2) CCB- Can cause reflex tachycardia 3) Organic Nitrates- Beta Blockers, verapamil and diltiazem can suppress nitroglycerin-induced tachycardia 4) Drug that increases myocardial efficiency- CCBs inhibit CYP3A4 and will increase levels of ranolazine

Question 2

1) BBs 2) CCBs 3) Nitroglycerin 4) Ranolazine & their common side effects

Answer 2

1) BB - fatigue 2) CCB - constipation 3) nitroglycerin - orthostatic hypotension 4) Ranolazine - QT prolongation

Question 3

1) Sublingual nitroglycerin, 2) BB, 3) CCB, 4) long acting nitrate

Answer 3

1) Sublingual nitroglycerin is contraindicated in patients using phosphodiesterase type 5 inhibitors (sildenafil), 2) Beta blockers may precipitate an MI or increase incidence/intensity of angia if stopped abruptly, 3) Calcium channel blockers should be used in caution for patients taking beta blockers or patients that experience bradycardia, heart failure, or AV block (this does not apply to nifedipine or other dihydropyridines). 4) Long acting nitrates can cause headaches.

Question 4

1) Beta Blockers 2)CCBs 3) organic nitrates 4) ranalozine

Answer 4

1) BB-reduction of contractility 2) nifidepine is likely to cause reflex tachycardia 3) organic nitrates-orthostatic hypotension

Question 5

Drug classes: Nitrates, B blockers, Calcium channel blocker and Ranolazine

Answer 5

Nitrates - Headache, B blockers - bradycardia, Calcium channel blockers - reflext tachycardia and Ranolazine - QT prolongation

Question 6

1. Nitroglycerin, 2. beta blockers, 3. calcium channel blocker, 4. long acting nitrate

Answer 6

1. headache, orthostatic hypotension, reflex tachycardia 2. bradycardia, decreased atrioventricular conduction 3. reflex tachycardia 4. headaches, tolerance with continuous administration

Question 7

1. Nitroglycerin, 2. Beta Blockers, 3. Calcium Channel Blockers, 4. Long-acting Nitrate

Answer 7

1. headache, orthostatic hypotension, reflex tachycardia (occur secondary to vasodilation). 2. Bradycardia, decreased AV conduction, reduction of contractility, bronchoconstriction. 3. reflex tachycardia. 4. headaches, tolerance with continuous medication use.

Question 8

1. Nitroglycerin 2. Beta Blockers 3. Calcium Channel Blockers 4. Ranolazine

Answer 8

1- Nitroglycerin can intensify the effects of other hypotensive agents. Exercise caution and care when nitro is used concurrently with B blockers, CCBs, diuretics, PDE-5, and any other drug that may lower BP. Patient should avoid alcohol. 2- Blockade of B2 receptors in the lung can promote bronchoconstriction, so beta blockers should be used with caution in patients with asthma. If necessary, B1 selective agent (metoprolol) should be used. 3- Combining CCBs with B blockers will increase the risk of cardiosuppression. CCBs (like Verapamil) will decrease heart rate, AV conduction, and contractility. 4- Do not combine Ranolazine with drugs that prolong QT interval (e.g., quinidine, sotalol). Drugs that prolong QT can increase the risk for torsades de pointes in patients taking Ranolazine.

Question 9

1. Beta blockers 2. Calcium channel blockers 3. Organic nitrates 4. Ranolazine

Answer 9

1. Beta blockers- Bradycardia, decreased atrioventricular conduction, and reduction of contractility. 2. CCBs- Reflex tachycardia. 3. Headache, orthostatic hypotension, and reflex tachycardia. Drug interactions for nitroglycerin include intensification of other hypotensive agents, as well as suppression of nitroglycerin-induced reflex tachycardia by beta blockers, verapamil and diltiazem. 4. QT prolongation and associated risk for torsades de pointes. Drug interactions for ranolazine include other drugs that prolong QT interval (quinidine, solatol), calcium channel blockers (can increase levels of ranolazine), and CYP3A4 inhibitors (increase the levels of ranolazine, and therefore increase the risk of torsades de pointes). Some of these CYP3A4 inhibitors include grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungals, and some calcium channel blockers.

Question 10

Nitroglycerin, B- blockers, CCB, Ranolazine

Answer 10

” Nitrates, headache , orthostatic hypotension. BB
can cause bradycardia,decrease atrioventricular
conduction and reduction of heart contractility.
CCB also causes dilation of peripheral arterioles
by lowerinng BP and inducing reflex tachycardia.
Ranolazine causes QT prolongation which may
increase the risk of torsade de pointes.
Ronalozine is contra-indication for patients
with hepatic impairment and inhibition in
CYP3A4.”

Question 11

1.Beta Blockers 2. Calcium Channel Blockers 3. Nitroglycerin 4. Ranolazine

Answer 11

1. Beta Blockers can cause cold hands and feet, fluid rentention and or worsening heartfailure. 2. Side effects of CCBs include constipation, palpitations and rash. 3. Nitroclycerin side effects can include difficulty or labored breathing, feeling faint, dizzy, or lightheadedness, and or feeling of warmth or heat. 4. Side effects of Ranolazine are rapid weight gain and or hearing loss